Atrium Health Navicent Women's Care Urogynecology & Pelvic Surgery

Minimally invasive Burch urethropexy

What is a Burch urethropexy?

A Burch urethropexy is a procedure to correct stress urinary incontinence (SUI). SUI is a type of urinary incontinence that is defined as involuntary leakage of urine related to an increase in intraabdominal pressure that occurs during sneezing, laughing, coughing or exercise. It is a very common condition that occurs in 1 in 3 women.

SUI occurs when the supports of the urethra are weakened allowing for hypermobility or instability of the urethral. The Burch urethropexy was original performed as an abdominal procedure. Sutures are placed in the retropubic space (space of Retzius) to suspend and stabilize the urethra.

How is the procedure performed?

The Burch urethropexy is an abdominal procedure performed to correct stress urinary incontinence. It involves placement of permanent sutures next to the urethra to suspend and support and correct hypermobility of the urethra that occurs due to weakness in the normal supports. A total of two stitches are placed on each side, one at the level of the bladder neck and the other at the level of the midurethra.

While traditionally performed through an large incision in the abdomen, Dr. Kow offers minimally invasive Burch urethropexy, which is performed either laparoscopically or with robotic assistance.

What are the advantages of minimally invasive Burch urethropexy?

Minimally invasive Burch urethropexy provides similar results to abdominal approach, while providing some additional benefits to you. These include the following:

• Decreased blood loss during surgery
• Decreased pain after surgery
• Faster return to normal activities
• Smaller incisions

It is important to ask your surgeon if they are trained to perform minimally invasive Burch urethropexy since it often requires additional training to perform. Typically, performing this procedure requires additional training that is obtained through a fellowship in FPMRS, like Dr. Kow.

What should I expect?

After initial consultation with Dr. Kow, you may be asked to undergo some bladder testing (urodynamics) prior to surgery. Prior to surgery, you will need to attend a preoperative visit with Dr. Kow and draw some basic lab work. Should you need surgical clearance, you will be asked to obtain this prior to surgery.

The surgical procedure takes approximately 1 hour to complete. It utilizes several small incisions in the abdomen to allow the surgeon to use laparoscopic instruments to complete the surgery. If the robotic approach is utilized, similar incisions are created to allow placement of instruments.

What is my recovery time?

Typical recovery time is one overnight stay at the hospital. While pain tolerance is variable among patients, most patients report minimal pain with laparoscopic or robotic Burch urethropexy.

Overall recovery time includes six weeks with some activity restrictions, however patients are often able to return to a normal routine shortly after surgery. Restrictions including the following:

• No heavy lifting of more than 10 lbs for 6 weeks
• No tub baths for 6 weeks
• No sexual intercourse for 6 weeks
• No driving while on narcotic pain medications

What are the risks of the procedure?

Complications from minimally invasive Burch urethropexy are typically very low. However with every procedure there always some risks including anesthesia problems, postoperative pain, intraoperative bleeding, infection, blood clots and damage to adjacent organs. With regards to a minimally invasive Burch urethropexy, some specific risks include the following:

• postoperative urinary tract infection
• voiding dysfunction
• bladder injury

Will my insurance company cover the procedure?

Most insurance policies will cover minimally invasive Burch urethropexy. Our office will help you with obtaining prior authorization if your insurance policy requires it. If you have further questions, contact your insurance carrier to determine the details regarding your coverage.